How does Parkinson’s disease affect cognitive function. What are the main types of dementia associated with Parkinson’s. What treatments are available for managing Parkinson’s disease dementia symptoms. How can caregivers support individuals with Parkinson’s-related cognitive decline.

The Link Between Parkinson’s Disease and Cognitive Decline

Parkinson’s disease (PD) is primarily known for its motor symptoms, such as tremors and slowed movement. However, cognitive changes are also common non-motor symptoms that can significantly impact a person’s quality of life. As PD progresses, cognitive decline can become more severe, potentially leading to dementia.

Approximately half of individuals with Parkinson’s experience mild cognitive impairment, characterized by noticeable changes in memory and thinking that don’t significantly interfere with daily activities. In more advanced stages, some people may develop more severe cognitive issues, including dementia.

What defines dementia in Parkinson’s disease?

Dementia in Parkinson’s disease refers to permanent cognitive changes that are significant enough to impact daily living. These changes can affect memory, thinking, and behavior, often compounding the challenges posed by motor symptoms. The combination of cognitive and movement impairments can severely limit a person’s ability to participate in social activities and perform basic tasks.

Types of Dementia Associated with Parkinson’s Disease

The accumulation of a protein called alpha-synuclein in the brain is central to Parkinson’s disease. These protein clumps, known as Lewy bodies, can disrupt normal brain function and contribute to cognitive decline. Two main types of dementia are associated with Lewy bodies:

• Parkinson’s Disease Dementia (PDD): This type is diagnosed when significant cognitive decline occurs after a year or more of experiencing motor symptoms, typically many years after the initial PD diagnosis.
• Dementia with Lewy Bodies (DLB): In this case, cognitive decline is the earliest symptom, or cognitive and motor symptoms begin and progress together.

Both PDD and DLB fall under the broader category of Lewy body dementia (LBD), reflecting their shared underlying pathology.

Common Symptoms of Parkinson’s Disease Dementia

Parkinson’s disease dementia can manifest in various ways, affecting thinking, memory, behavior, and perception. Understanding these symptoms is crucial for early detection and management.

Memory Changes and Confusion

Cognitive impairment in PDD can range from mild to severe:

• Difficulty with simple tasks, such as making coffee
• Problems with concentration and learning new information
• Short-term and long-term memory impairment
• Disorientation and confusion in familiar settings

Mood Changes, Hallucinations, and Paranoia

PDD can significantly impact a person’s emotional state and perception of reality:

• Increased agitation, irritability, or aggression
• Hallucinations – seeing, hearing, or feeling things that aren’t real
• Delusions – unrealistic beliefs, often involving paranoid thinking or suspicion

Visual Perception Difficulties

People with PDD may experience challenges related to visual processing:

• Trouble finding objects in cluttered environments
• Difficulty navigating familiar or new places
• Increased challenges in low-light conditions or with macular degeneration

Language and Communication Challenges

PDD can affect various aspects of communication:

• Difficulty naming or misidentifying objects
• Trouble comprehending complex sentences or detailed information
• Speech production problems, including word-finding difficulties
• Slowed or slurred speech due to motor symptoms

Diagnosing Parkinson’s Disease Dementia

Accurately diagnosing PDD is crucial, as various factors can mimic dementia symptoms in Parkinson’s patients. Mood disorders, sleep problems, medication side effects, and other medical conditions can all impact cognitive function in PD. A comprehensive evaluation by a neurologist or movement disorders specialist is essential for proper diagnosis and treatment planning.

What diagnostic tools are used to assess cognitive decline in Parkinson’s patients?

Diagnosing PDD typically involves a combination of clinical assessment, cognitive testing, and sometimes brain imaging. Neuropsychological evaluations can help differentiate between mild cognitive impairment and more severe dementia. Additionally, ruling out other potential causes of cognitive symptoms is an important part of the diagnostic process.

Treatment Options for Parkinson’s Disease Dementia

While there is currently no cure for PDD, various treatment approaches can help manage symptoms and improve quality of life for patients and their caregivers.

Pharmacological Interventions

Several medications originally developed for Alzheimer’s disease have shown benefits in treating PDD:

• Rivastigmine: The only FDA-approved medication specifically for PDD
• Donepezil: A cholinesterase inhibitor that may improve cognitive function
• Galantamine: Another cholinesterase inhibitor that can help with memory and thinking

These medications work by increasing levels of certain neurotransmitters in the brain, potentially improving cognitive function and reducing behavioral symptoms.

Non-Pharmacological Approaches

Cognitive remediation therapy, provided by neuropsychologists or speech-language pathologists, can be beneficial for people with PDD. This therapy focuses on teaching strategies to compensate for cognitive impairments and improve daily functioning.

Are there lifestyle modifications that can help manage PDD symptoms?

While medication and therapy play crucial roles in managing PDD, certain lifestyle changes can also be beneficial:

• Maintaining a structured daily routine
• Engaging in regular physical exercise, as appropriate for the individual’s abilities
• Participating in mentally stimulating activities
• Ensuring adequate sleep and nutrition
• Minimizing environmental distractions and stressors

The Impact of Parkinson’s Disease Dementia on Caregivers

Caring for someone with PDD can be challenging and stressful for family members and other caregivers. The combination of motor and cognitive symptoms often requires increasing levels of support and supervision as the disease progresses.

How can caregivers best support individuals with PDD?

Effective caregiving for someone with PDD involves a multifaceted approach:

• Creating a safe and supportive home environment
• Assisting with daily activities while encouraging independence when possible
• Managing medications and medical appointments
• Providing emotional support and maintaining social connections
• Adapting communication strategies to accommodate cognitive changes

The Importance of Caregiver Self-Care

Caregivers of individuals with PDD must prioritize their own well-being to provide effective care. This includes:

• Seeking respite care options to prevent burnout
• Joining support groups for caregivers of people with Parkinson’s or dementia
• Maintaining personal health through regular check-ups and self-care practices
• Educating oneself about PDD to better understand and manage the condition

Research and Future Directions in Parkinson’s Disease Dementia

Ongoing research aims to improve our understanding of PDD and develop more effective treatments. Current areas of focus include:

• Identifying biomarkers for early detection of cognitive decline in PD
• Developing new medications that target the underlying causes of PDD
• Exploring non-invasive brain stimulation techniques to improve cognitive function
• Investigating the potential of lifestyle interventions to slow cognitive decline

What promising developments are on the horizon for PDD treatment?

Several emerging approaches show potential for improving PDD outcomes:

• Gene therapies targeting alpha-synuclein accumulation
• Advanced neuroimaging techniques for earlier and more accurate diagnosis
• Personalized medicine approaches based on genetic and biomarker profiles
• Novel cognitive training programs utilizing virtual reality technology

As research progresses, these innovations may lead to more effective strategies for preventing, diagnosing, and treating Parkinson’s disease dementia.

Living with Parkinson’s Disease Dementia: Strategies for Patients and Families

While PDD presents significant challenges, there are ways to maintain quality of life and cope with the condition:

Adapting the Home Environment

Creating a safe and supportive living space is crucial for individuals with PDD:

• Removing tripping hazards and installing handrails
• Using clear labels and signs to aid navigation and task completion
• Implementing smart home technologies for safety and assistance
• Ensuring adequate lighting to reduce visual perception difficulties

Maintaining Social Connections

Social engagement is vital for cognitive and emotional well-being:

• Participating in support groups for people with PD and their caregivers
• Engaging in community activities adapted to the individual’s abilities
• Utilizing technology for virtual social interactions when in-person meetings are challenging
• Encouraging visits from family and friends in a structured, low-stress manner

Planning for the Future

Early planning can help address future care needs and legal considerations:

• Discussing care preferences and documenting wishes through advance directives
• Exploring long-term care options and financial planning
• Designating power of attorney for healthcare and financial decisions
• Regularly reviewing and updating plans as the condition progresses

By implementing these strategies and working closely with healthcare providers, individuals with PDD and their families can better navigate the challenges of the condition and maintain the highest possible quality of life.

Dementia | Parkinson’s Foundation

Parkinson’s disease (PD) is known most for its associated movement (or motor) symptoms, such as tremor and slowed movement, but cognitive changes can also be among the common PD non-movement symptoms.

About half of those with Parkinson’s will be affected by mild cognitive impairment — changes in memory and thinking that are noticeable, but not enough to affect daily activities.

As the disease progresses, people living with PD can develop more significant or severe memory and thinking problems, sometimes called dementia. The term dementia means that a person has permanent cognitive changes that are significant enough to impact daily living. The combination of movement and cognitive impairments can be particularly challenging, even limiting a person with Parkinson’s ability to participate in social settings and perform basic activities.

Dementia or significant cognitive decline can also seriously impact care partners and is associated with care partner stress. To best care for those living with the disease, care partners of people with Parkinson’s-related dementia must also prioritize self-care.

Issues and Parkinson’s symptoms associated with mood, sleep, medications or other medical problems can all look like dementia. Because many other factors can impact cognitive skills in PD, an accurate diagnosis is essential.

Types of Dementia

Changes in the structure and chemistry of the brain can cause memory and thinking problems in Parkinson’s. Alpha-synuclein, a protein that is central to Parkinson’s, forms sticky clumps, called Lewy bodies, that can disrupt normal brain functioning and lead to dementia. Because of this, the term ‘Lewy body dementia (LBD)’ may sometimes be used.

Lewy body dementia includes two different types of related dementias, distinguished by which symptoms start when:

1. Parkinson’s disease dementia (PDD) – diagnosed when a person living with PD experiences significant cognitive decline after a year or more of motor symptoms (most typically after many years of experiencing motor symptoms).
2. Dementia with Lewy Bodies (DLB) – diagnosed when cognitive decline is the earliest symptom, or when cognitive decline and motor symptoms begin and progress together.

Deep Dive with Our Book

Cognition: A Mind Guide to Parkinson’s Disease explains what affects your thinking and what cognitive changes can happen in Parkinson’s. Don’t miss our coping tips and stories that highlight how people in the PD community manage dementia.

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Symptoms of Dementia

Potential thinking, memory and behavior changes among people with Parkinson’s disease dementia can be wide-ranging.

Memory Changes and Confusion

Signs can range from forgetting how to do simple tasks, such as making coffee, to difficulty concentrating, learning, remembering or problem-solving:

• People with PDD can become disoriented and confused.
• People with PDD can experience short- and long-term memory impairment.

Mood Changes, Hallucinations and Paranoia

People with PDD can become agitated, irritable or even aggressive. Other Parkinson’s disease dementia experiences can include:

• Hallucinations – seeing, hearing or feeling things that are not real.
• Delusions – strange or unrealistic beliefs including paranoid thinking, suspicion or distrust.

Visual Perception Difficulties

PDD can cause subtle visual-perceptual problems. These problems can contribute to visual misperceptions or illusions. This can include difficulty finding objects in a busy space or trouble navigating familiar or unfamiliar places. Nighttime low light or macular degeneration can increase these challenges.

Language Challenges

People with Parkinson’s disease dementia can experience communication difficulties:

• As PDD advances, people may experience problems naming objects or may misname them.
• Difficulty comprehending complex sentences, such as a question or information without giving more detail.
• Speech problems, such as trouble producing words even when they can think of the word they want to say. Movement symptoms can cause slowed or slurred speech.

Treatment of Dementia

Talk to your PD doctor, preferably a neurologist or movement disorders specialist, about dementia concerns. While there is no way to stop the disease’s progression, a doctor can help manage the symptoms.

• Studies have shown that prescription medications developed for Alzheimer’s disease have benefits in PD dementia, including rivastigmine (the only FDA-approved PDD medication), donepezil and galantamine.

• Your doctor may recommend you work with a specially trained neuropsychologist or speech-language pathologist who can offer cognitive remediation therapy. This technique teaches people with cognitive impairment ways to compensate for memory or thinking problems by:

  • Testing that identifies cognitive strengths to overcome weaker areas of thinking.
  • Highlighting concrete strategies to help with daily functioning.

  People in the early stages of PDD can use cognitive remediation skills independently. Care partners and family members can help apply the strategies as dementia progresses.

• This type of treatment applies changes to the environment to minimize memory, vision and perception or orientation difficulties. Strategies include decluttering and simplifying living areas to reduce confusion and using low-level nighttime lighting to reduce visual misperceptions and confusion.

  A structured, regular day-to-day routine can also help people with Parkinson’s-related dementia feel more comfortable.

The Differences Between Parkinson’s Dementia and Alzheimer’s Disease

The advanced cognitive changes that impact daily living in Alzheimer’s and Parkinson’s are both types of dementia.

Parkinson’s disease dementia (PDD) can occur as Parkinson’s advances, after several years of motor symptoms. Dementia with Lewy Bodies (DLB) is diagnosed when cognitive decline happens first, or when Parkinson’s motor symptoms and cognitive decline occur and progress closely together.

Alzheimer’s, a fatal brain disease, causes declines in memory, thinking and reasoning skills. Physicians (often with the help of specialists such as neurologists, neuropsychologists, geriatricians, and geriatric psychiatrists) can diagnose Alzheimer’s. Visit the Alzheimer’s Association to learn the 10 signs of Alzheimer’s disease.

Parkinson’s disease dementia tends to be less disabling than Alzheimer’s disease. People with Alzheimer’s disease have language difficulties earlier than people with Parkinson’s, and they are unable to form new memories unlike in PD.

FAQs: Dementia and Parkinson’s

• Yes. Alzheimer’s disease and Parkinson’s disease affect different proteins in the brain, making it possible for a person with Parkinson’s to also have Alzheimer’s.

• While rare, it is possible for a person with PD to be diagnosed with Parkinson’s disease dementia and Alzheimer’s disease. A neurologist who treats Parkinson’s with a neuropsychologist, geriatrician or a geriatric psychiatrist can help diagnose Alzheimer’s disease.

• According to recent research, up to 70 percent of people with Parkinson’s will develop dementia as a part of the disease progression.

• There is no single test for PDD. The diagnosis is made clinically. If you or someone you spend time with notices cognitive changes, it is important to discuss them with your care team. If you don’t have a care team in place, it’s important to find a specialist or physician familiar with dementia or geriatric medicine. Call the Parkinson’s Foundation Helpline 1-800-4PD-INFO (1-800-473-4636) for a referral.

• People with Parkinson’s-related dementia often want to know how the disease can impact their lifespan. While people with Parkinson’s can expect a similar lifespan to the general population, studies show both Parkinson’s disease dementia and Lewy body dementia can shorten lifespan, generally due to medical complications from the disease, rather than the disease itself.

PD Dementia and Safety Concerns

Safety issues should be considered and monitored from the time of diagnosis. As PDD progresses, ensure that your loved one is not left alone and try to:

• Evaluate driving privileges before safety is a concern. Your doctor can make a driving evaluation referral.
• Work out legal and financial issues and safeguard finances. People with dementia are at greater risk of falling victim to scams and fraud.
• Minimize prescription risks. Confirm with the doctor the medication names and doses of the person with PD. If the person is in dementia’s early stages and capable, fill up their weekly pill box together and monitor use.
• Look into medical alert systems. These systems can be critical in the event of a fall or if your loved one wanders outside of the home. Many types of systems are available, from bracelets and pendants to smartwatches with fall detection and one-button connections to 911.
• Evaluate gun safety. If your loved one owns a firearm or has one in the home, consider bringing it up with their doctor and taking additional safety precautions.

Tips for Communicating with a Person with PDD

PD-related mood and motor changes can impact communication; cognitive changes and Parkinson’s disease dementia can further these difficulties.

• Stay calm and be patient. It is not usually helpful to try to reason or argue with someone experiencing a hallucination or delusion. If the person is frightened by the hallucination or delusion, try to redirect their attention to something else.
• Acknowledging what the person is seeing, even if you do not see it, can reduce stress.
• Speak slowly and at eye level. Communicate in simple sentences.
• Ask one question at a time and wait for an answer.
• Limit distractions. Turn off the TV or radio before asking a person with PDD to do something.
• Consider causes behind disruptive behavior. Can your loved one be hungry, thirsty, tired, in pain, frustrated, lonely or bored?
• If the person is stuck on an idea, try agreeing with them, then changing the subject.
• It’s okay to use humor to diffuse stressful situations but avoid negative humor or sarcasm ― these can be misunderstood.

Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor and Dr. Sydney M. Spagna, Clinical Fellow at the University of Michigan.

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Parkinson’s Disease Dementia | Memory and Aging Center

Parkinson’s disease dementia (PDD) is defined by changes in thinking and behavior in someone with a diagnosis of Parkinson’s disease (PD). PD is an illness characterized by gradually progressive problems with movement, most commonly involving slowing of movements, a tremor present at rest, and walking instability which can cause falls. PDD has similarities to a related condition called dementia with Lewy bodies (DLB) that also causes changes in thinking, behavior and movement, but in DLB the movement problems start after the thinking and behavior symptoms.

What Causes PDD?

The cause of PDD is unknown. Scientists know that in Parkinson’s disease, there is a large build-up of a protein called alpha synuclein that clumps together to form “Lewy bodies.” Alpha synuclein occurs normally in the brain, but we do not yet understand what causes it to build up in large amounts. As more and more proteins clump in the nerve cells, the cells lose their ability to function and eventually die. Early in PD, the disease process affects parts of the brain important for movement, but as the disease progresses, eventually parts of the brain that are important for mental functions such as memory and thinking become injured.

How is Age Related to PDD?

Both PD and PDD are more common with increasing age. Most people with PD start having movement symptoms between ages 50 and 85, although some people have shown signs earlier. Up to 80% of people with PD eventually develop dementia. The average time from onset of movement problems to the development of dementia is about 10 years.

What Happens in PDD?

People with PDD may have trouble focusing, remembering things or making sound judgments. They may develop depression, anxiety or irritability. They may also hallucinate and see people, objects or animals that are not there. Sleep disturbances are common in PDD and can include difficulties with sleep/wake cycle (asleep during the day and awake at night) or “REM behavior disorder,” which involves acting out dreams.

PDD is a disease that changes with time. A person with PDD can live many years with the disease. Research suggests that a person with PDD may live an average of 5–7 years with the disease, although this can vary from person to person.

Are There Medicines to Treat PDD?

Though there is no cure for PDD yet, there are medications that help manage the symptoms. These medications are called cholinesterase inhibitors, and they can help if a person with PDD is having memory problems. Some examples of these medicines are donepezil, rivastigmine and galantamine. Sleep problems may be managed by sleep medications such as melatonin.

Because people with PDD are usually very sensitive to medications, any new medication, even one that is not being used for the brain, needs to be reviewed with the person’s provider to avoid potential contraindication.

How Can We Manage Hallucinations?

It may not be necessary to treat all hallucinations of a person with PDD. Hallucinations are often harmless, and it is okay to allow them to happen, as long as they are not disruptive or upsetting to the person or surroundings. Sometimes, recognizing the hallucination and then switching the topic might be an efficient way of handling frustrations that occur because of a hallucination. If hallucinations need medical treatment, your provider may be able to discuss and suggest some options. However, many of the medications used to treat hallucinations may make movement symptoms worse.

How Can We Support the Sleep/Wake Cycle of PDD?

For people with PDD who are confused about the day-night cycle, some daily strategies can be helpful. At night, starting a “lights out” routine that happens at the same hour every day, where all curtains are closed and lights are turned off, can help the person understand that it is sleep time. During the day, opening the curtains, allowing the person with PDD to spend as much time in the daylight as possible, avoiding naps, and organizing stimulating activities, can be helpful. Having lots of calendars and clocks in every room might also help a person with PDD be less confused about the time of day.

What Other Things Help?

There are various ways to help a person with PDD. Speech therapy may help improve communication between people with PDD and others. Physical therapy may help strengthen and stretch stiff muscles and help to prevent falls.

Research has shown that physical exercise helps to enhance brain health and improves mood and general fitness. A balanced diet, enough sleep and limited alcohol intake are other important ways to promote good brain health. Other illnesses that affect the brain, such as diabetes, high blood pressure and high cholesterol, should also be treated if present.

Resources

• A Patient’s Guide to Parkinson’s Disease Dementia (PDF)
• What Is Lewy Body Dementia?
• National Parkinson Foundation
• Michael J. Fox Foundation for Parkinson’s Research
• Parkinson’s Disease Foundation
• Alzheimer’s Association
• Family Caregiver Alliance
• National Institutes of Health

Resources for Providers

• A Healthcare Provider’s Guide to Parkinson’s Disease Dementia (PDF)
• Clinical Diagnostic Criteria for Dementia Associated with Parkinson’s Disease
• Dementia Resources for Health Professionals

Participate in Research

• ADRC: New Approaches to Dementia Heterogeneity
• The Parkinson’s Spectrum Disorders Center: Understanding a Complex Set of Disorders
• Clinical trials at UCSF
• ClinicalTrials. gov

Dementia due to Parkinson’s disease

Dementia in Parkinson’s disease is a decrease in the thinking process that many people living with Parkinson’s disease develop for at least a year after diagnosis.

Contents

• About dementia in Parkinson’s disease
• Prevalence
• Causes and risk factors
• Diagnostics
• Treatment

Pro dementia in Parkinson’s disease

Parkinson’s disease brain changes begin in a region that plays a key role in movement, leading to early symptoms, including tremors, tremors, muscle stiffness, shuffling, and slouching posture, difficulty initiating movement, and lack of facial expression.

As Parkinson’s disease-induced brain changes gradually worsen, they often affect mental functions such as memory, the ability to pay attention, make judgments, and plan steps to complete a task.

The key brain changes associated with Parkinson’s disease and dementia in this disease are abnormal microscopic deposits that consist generally of alpha-synuclein, a protein found in the brain, the function of which is still not clearly understood. These deposits are called “Lewy bodies” after Dr. Frederick H. Lewy, M.D., a neurologist who discovered them while working in the laboratory of Dr. Alois Alzheimer in early 1090. Lewy bodies are also found in several other brain disorders, including dementia with Lewy bodies. Evidence suggests that dementia with Lewy bodies, Parkinson’s disease, and dementia in Parkinson’s disease may be associated with the same abnormalities that underlie brain processing of alpha-synuclein.

Another complicating factor is that many people with Parkinson’s disease and Lewy body dementia also have the plaques and glomeruli characteristic of Alzheimer’s brain changes.

A study published July 29, 2019 in Scientific Reports suggests that Lewy bodies are a problem because they extract alpha-synuclein protein from the nucleus of brain cells. The study, which looked at living mouse cells and post-mortem human brain tissue, showed that these proteins perform an important function by repairing breaks that occur in large strands of DNA present in the nuclei of every cell in the body. The role of alpha-synucleins in repaired DNA may be critical in preventing cell death. This function can be lost in brain diseases such as Parkinson’s disease and dementia with Lewy bodies, leading to neuronal death.

Prevalence

Parkinson’s disease is a fairly common neurological disorder in the elderly, estimated to affect nearly 2% of people over 65 years of age. The National Parkinson Foundation estimates that between 50 and 80% of people with dementia have symptoms.

Causes and risk factors

Research has shown that the average time from the onset of Parkinson’s disease to the development of dementia is about 10 years. However, there are factors that, once diagnosed with Parkinson’s, may increase the likelihood of future dementia, such as:

• advanced age;
• movement problems;
• moderate cognitive impairment.

Additional risk factors may include:

• the presence of hallucinations in a person who does not yet have other symptoms of dementia;
• excessive daytime sleepiness;
• Parkinson’s symptoms known as postural instability and gait disturbances, including “freezing”, difficulty initiating movement, problems with balance and falling.

The following symptoms usually accompany the disease:

• changes in memory, trouble concentrating;
• problems with the interpretation of visual information;
• muffled speech;
• visual hallucinations;
• delusions, especially paranoid ideas;
• depression;
• irritability;
• alarm;
• sleep disturbance including excessive daytime sleepiness.

Diagnosis

There is no single test or combination of tests that can definitively determine if a person has Parkinson’s dementia. The diagnosis is made when a person is first diagnosed with Parkinson’s disease based on movement-related symptoms, and symptoms of dementia do not appear until a year or more later.

When the disease occurs, damage and destruction of the brain cells and over time, the symptoms of the disease only worsen. The rate of progression can fluctuate over wide time ranges.

Treatment

There is currently no way to slow or stop the damage to brain cells caused by Parkinson’s dementia. Current strategies only focus on improving symptoms, and only working closely with a physician can help determine which medications are best for each individual patient.

Cholinesterase inhibitors (drugs used to treat cognitive changes in Alzheimer’s disease) may help with symptoms of dementia in Parkinson’s disease, including visual hallucinations, sleep disturbances, and changes in thinking and behavior.

Levodopa-carbidopa may be indicated for the treatment of Parkinson’s movement symptoms. However, sometimes it can increase hallucinations and confusion. Deep brain stimulation is contraindicated in the treatment of dementia in Parkinson’s disease. Selective serotonin reuptake inhibitors (SSRIs) are used to treat depression, which is common in both ordinary dementia and dementia associated with Parkinson’s disease.

Caution: Antipsychotics such as haloperidol, fluphenazine, or thioridazine should be avoided because about 60% of patients experience worsening Parkinson’s symptoms, swallowing problems, or neuroleptic malignant syndrome, a life-threatening condition.

Electronic source:

https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/parkinson-s-disease-dementia

Parkinson’s disease

Dementia in Parkinson’s disease is a decrease in the thinking process that many people living with Parkinson’s disease develop for at least a year after diagnosis.

Contents

• About dementia in Parkinson’s disease
• Prevalence
• Causes and risk factors
• Diagnostics
• Treatment

Pro dementia in Parkinson’s disease

Parkinson’s disease brain changes begin in a region that plays a key role in movement, leading to early symptoms, including tremors, tremors, muscle stiffness, shuffling, and slouching posture, difficulty initiating movement, and lack of facial expression.

As the changes in the brain caused by Parkinson’s gradually worsen, they often affect mental functions such as memory, the ability to pay attention, make judgments, and plan steps to complete a task.

The key brain changes associated with Parkinson’s disease and dementia in this disease are abnormal microscopic deposits that consist generally of alpha-synuclein, a protein found in the brain, the function of which is still not clearly understood. These deposits are called “Lewy bodies” after Frederick H. Levy, M.D., a neurologist who discovered them while working in the laboratory of Dr. Alois Alzheimer in the early 1090 years. Lewy bodies are also found in several other brain disorders, including dementia with Lewy bodies. Evidence suggests that dementia with Lewy bodies, Parkinson’s disease, and dementia in Parkinson’s disease may be associated with the same abnormalities that underlie brain processing of alpha-synuclein.

Another complicating factor is that many people with Parkinson’s disease and Lewy body dementia also have the plaques and glomeruli characteristic of Alzheimer’s brain changes.

A study published July 29, 2019 in Scientific Reports suggests that Lewy bodies are a problem because they extract alpha-synuclein protein from the nucleus of brain cells. The study, which looked at living mouse cells and post-mortem human brain tissue, showed that these proteins perform an important function by repairing breaks that occur in large strands of DNA present in the nuclei of every cell in the body. The role of alpha-synucleins in repaired DNA may be critical in preventing cell death. This function can be lost in brain diseases such as Parkinson’s disease and dementia with Lewy bodies, leading to neuronal death.

Prevalence

Parkinson’s disease is a fairly common neurological disorder in the elderly, estimated to affect nearly 2% of people over 65 years of age. The National Parkinson Foundation estimates that between 50 and 80% of people with dementia have symptoms.

Causes and risk factors

Research has shown that the average time from the onset of Parkinson’s disease to the development of dementia is about 10 years. However, there are factors that, once diagnosed with Parkinson’s, may increase the likelihood of future dementia, such as:

• advanced age;
• movement problems;
• moderate cognitive impairment.

Additional risk factors may include:

• the presence of hallucinations in a person who does not yet have other symptoms of dementia;
• excessive daytime sleepiness;
• Parkinson’s symptoms known as postural instability and gait disturbances, including “freezing”, difficulty initiating movement, problems with balance and falling.

The following symptoms usually accompany the disease:

• changes in memory, trouble concentrating;
• problems with the interpretation of visual information;
• muffled speech;
• visual hallucinations;
• delusions, especially paranoid ideas;
• depression;
• irritability;
• alarm;
• sleep disturbance including excessive daytime sleepiness.

Diagnosis

There is no single test or combination of tests that can definitively determine if a person has Parkinson’s dementia. The diagnosis is made when a person is first diagnosed with Parkinson’s disease based on movement-related symptoms, and symptoms of dementia do not appear until a year or more later.

When the disease occurs, damage and destruction of the brain cells and over time, the symptoms of the disease only worsen. The rate of progression can fluctuate over wide time ranges.

Treatment

There is currently no way to slow or stop the damage to brain cells caused by Parkinson’s dementia. Current strategies only focus on improving symptoms, and only working closely with a physician can help determine which medications are best for each individual patient.

Cholinesterase inhibitors (drugs used to treat cognitive changes in Alzheimer’s disease) may help with symptoms of dementia in Parkinson’s disease, including visual hallucinations, sleep disturbances, and changes in thinking and behavior.

Levodopa-carbidopa may be indicated for the treatment of Parkinson’s movement symptoms. However, sometimes it can increase hallucinations and confusion. Deep brain stimulation is contraindicated in the treatment of dementia in Parkinson’s disease.